Post-Orchiopexy and Inguinal Hernia Repair

Bill and I cringe everytime we look at the incisions and stitches but so far, it hasn't been enough to bring on a fainting spell. It just looks like it would hurt to be even moving around. But just a day after his most recent surgical procedure, our little trooper seemed like his usual self. The pediatric urologist was right about how it would be hard to keep Matthew from unallowed activities post-surgery such as climbing, running, and other vigorous activities. From his experience, he observed kids with Down syndrome to bounce back almost instantly. Matthew does have a relatively high tolerance for pain.

It was in October 2010 (last year) at his pediatrician's office when we first learned he might need to have surgery. A visit to a highly recommended pediatric urologist in December confirmed it. We were able to push it off until this summer. We were told that it was important to get it done but not urgent.

July 27, 2011 was the day of surgery - an orchiopexy and inguinal hernia repair (also closing the inguinal canal to prevent a potentially bigger problem down the road). On the same day last year, Matthew had a sedated ABR (hearing test). In October 2010, he had a tonsillectomy, adenoidectomy, and his second set of ear tubes. We hope he won't need more surgical procedures or other procedures that require anesthesia for a l-o-n-g time.

We hid all the riding toys in the unfinished side of our basement. We encouraged him to sit and listen to music, play on his vReader, mobigo, and on my iPhone. We encouraged drawing, play-doh, and other fine motor activities. But as hard as we tried, it seemed that he couldn't bear to miss a day of rough-housing with his little sister and annoying the cat - climbing up and down the living room chairs, in and out of the ball pool, running after the cat, and tickling Elizabeth.

The Day of Surgery
Matthew and I were at the hospital by 6:30am. Bill and Elizabeth stayed home. Surgery was at 8:30am. He was out of surgery by 9:45am. While recovering in the hospital, a few hours after surgery, he was in good spirits as long as I offered him a bottomless supply of apple juice and graham crackers. We were discharged at 1:45pm on the same day.

The caudal block, which is a regional anesthesia injected into the end of the spinal canal and administered in addition to general anesthesia, proved to be a very effective pain reliever for Matthew. He didn't need the tylenol with codeine until 8pm that evening.

Step Back in Potty Training
Potty training has taken a back seat and we have him in pull-ups all day instead of big boy underwear. We also figured that the pull-up would help keep the lower incision site dry. The discomfort in *that* area is making him go in the toilet more challenging than it was as he fusses more about using the toilet than he used to. Despite the resistance, he still has many successes at holding and keeping his pull-up dry. However, he finds it more comfortable to poop in the pull-up. We'll get back into it when the incisions have healed and the bruising is gone.

Recovering From Surgery: Days 1 to 9 Daily Diary

I kept a daily diary of Matthew's recovery from the tonsillectomy, adenoidectomy and bilateral myringotomy. It took 8 days before Matthew was back to his usual smiley, playful, mischievous self. I'd have to say days 2 to 7 were the hardest for me.

Day 1 - October 27
The day after surgery.

Matthew has hardly said anything. It's been mostly sporadic bouts of whimpering and crying. Matthew has a high tolerance for pain so for him to be acting this way is indicative of how raw and sore his throat is from the surgery. Plus, he's overtired from the whole ordeal.

We're managing the pain with regular liquid generic tylenol every 4 hours, including late night (9pm) and early morning (1am and 5pm) doses.

We have the option of giving him liquid Tylenol with codeine, which is a narcotic, but I don't want to be dealing with the possible adverse effects such as abdominal pain, nausea and constipation. The ENT also cautioned us about using it as he has seen kids in Matthew's age group (2 to 3?) have trouble with codeine and tend to do just fine with regular Tylenol. But he wrote us a prescription for it just in case we absolutely have to switch to it.

Other meds that we started today are liquid strawberry-flavored Amoxicillin twice a day for 10 days and Ciprodex ear drops twice a day for 3 days. Ibuprofen isn't allowed until after 2 weeks due to a bleeding risk.

We were discharged from the hospital after a restless night's stay. A tonsillectomy and adenoidectomy is typically an outpatient procedure but we opted to spend the night at the hospital to monitor Matthew's oxygen saturation level post-surgery and make sure he was doing fine overall. I was glad to see the IV removed from his hand yet I was very thankful that he had it in the whole time after the surgery, keeping him hydrated.

He has been refusing to drink or eat anything except for when I got him out of the hospital bed to play on the floor with his current favorite toy - Alphie the Learning Robot. At that time, he actually drank a small amount of apple juice and ate a serving of applesauce without any problems.

He hoarsely said, "Hi Dee" when Bill and Elizabeth arrived to take us home. I requested for a wagon, instead of a wheelchair, to transport Matthew to our car. Matthew loves wagon rides and I was hoping that would cheer him up a little but he was too wore out to manage a smile.





Day 2 - October 28
We had a rough first night at home. His breathing was horribly loud, rattly and a little wheezy. He snored when we were at the hospital but it wasn't bad like last night. I took him into the bathroom for a steam treatment at 1am, very worried about his breathing and hoping we didn't have to resort to using Prednisolone (liquid steroid), which his pediatrician prescribed last year to reduce airway swelling and make it easier for him to breathe. I'm not totally opposed to using it but I like to avoid it if I can due to the associated possible side effects. I'll have to see how he does tonight before talking to his pediatrician about it.

Overall, he's still very tired. He usually only takes one nap in the afternoon. Today, he napped from 9am to noon and again from 3pm to 5pm, making up for lost sleep.

Our main priorities during the recovery period are pain management and hydration.

This is such a frustrating time for him. He doesn't understand why I'm not allowing him to eat his favorite blueberry toaster waffles. On the bright side, the fact that he's not completely weaned off 2nd and 3rd stage baby food is a major PLUS considering he has to be on a soft food diet for 2 weeks. He uncomfortably ate a few spoonfuls of baby food, applesauce and yogurt melts today. He'd take a few spoonfuls of his baby food and then not want any more. His hunger motivates him to eat but the pain makes him not want to eat. He has been refusing milk and most food.

As for fluid intake, one of the best advice I received was from Maggie (from the blog Take a Walk on the Happy Side). She suggested ice cold water via oral syringe every 20 minutes or as often as possible to keep him hydrated. Dehydration will earn us a trip to the emergency room for IV fluids - something we'd like to avoid at all costs. With a lot of coaxing, he's been amenable to this method of drinking water, which is a good thing as he has refused water from ANY kind of cup.

Despite the pain and discomfort, my sweet little guy still made sure his little sister had enough toys to play with. She was the only one who has managed a little smile out of him today.


Day 3 - October 29
Last night was better. Seems like we will not have to use Prednisolone.

Tonight should be the last night for the 4-hour tylenol dosage. I feel bad waking him up in the middle of the night when he's sleeping so soundly. But I know the pain will be worse for him if I skip a dose this soon. And when the pain is worse, he will be less likely to drink or eat anything.

Today has been harder than yesterday. Numerous times, I was faced with a quandry - Do I comfort the 3-year old who is whimpering and crying from post-surgery discomfort and constipation? Or do I hold my crying 6-month old? Elizabeth was moved many times - from high chair to bumbo to playmat to exersaucer to jumperoo to rocking infant seat - so I could keep her semi-content and Matthew comforted in my arms and on my lap.

My sister-in-law and her 2 children came over to spend some time with Matthew and help keep his mind off his misery. Matthew was very happy to see his auntie and cousins. He was finally smiling! He and his big cousin played the classic game of "fetch" with a balloon. Repeatedly, he let it float up to the ceiling and enjoyed watching his big cousin get up on a little stool to reach up and retrieve it for him. They had lots of fun with that.



But as soon as they left, he was back to whimpering and crying.

Matthew ate and drank a little more today but he's still hurting. I've been pushing pears in an effort to solve his constipation issue. Pears have always helped him. He had skipped 3 days since Tuesday, which is unusual for him. He finally went today, straining and crying.

Today was the last day for the Ciprodex ear drops. That means one less struggle to deal with.

Day 4 - October 30
Matthew used to grind his teeth before the surgery but it was rare. It has gotten 10 times worse since the surgery. Is this his coping mechanism? Bill and I don't like it but there's nothing we can do. I've offered him his chewy tube, hoping he would chew that instead but he refuses and continues to grind. I can hear him grinding his teeth through the baby monitor.

He has also been drooling a lot, refusing to swallow his own saliva.

I'm beginning to quietly entertain the option of using Tylenol with codeine. Maybe that will help knock the pain down more. But the thought of the possible adverse effects hold me back.

Eating was tougher today. The ENT did say that the pain would peak on Day 4. He took a few sips of ice cold milk and some ice cold apple juice. His fluid intake is still nowhere near what he usually drank pre-surgery but administering ice cold water via oral syringe seems to be keeping him hydrated enough to avoid a hospital visit.

Our clothes have pink stains from the Amoxicillin and Tylenol. Not that I mind. The stains are simply a testament to the medicine battles that have ensued since Day 1. Most of the time he cooperates very well with taking his medicine. But there are a few times when he doesn't. The stains will easily come off in the wash.

I'm so thankful for the weekend. With Bill home during the day, taking care of Matthew was easier.

Day 5 - October 31
Matthew woke up better rested today. We skipped the middle of the night Tylenol doses and he did fine. He did wake up twice in the night coughing very badly though. I was sure he was going to throw up but he didn't. A little water via oral syringe helped. I guess his throat was dry. We've had the humidifier running in his room since Day 1. He had a dose of Tylenol as soon as he was up for the day.

A few more smiles and laughter than whimpers and cries today. But the smiles were short-lived. The pain was far from gone. Just when I begin to think he's feeling better, he burst into tears again. It was a see-saw throughout the day. The only way he would nap in the afternoon was on Bill in the rocker-recliner.



We managed to take him trick-or-treating with our neighbor for a short while around our neighborhood. We almost didn't because he was crying inconsolably leading up to the time we had planned to go. Thankfully, he calmed down and had a nice time trick-or-treating.



He finally ate some pasta shells with cheese sauce for dinner today and that seemed to help him feel better.

Day 6 - November 1
Our morning started out with crying after another rough night with a couple bouts of coughing and crying. Matthew wanted to be held. Elizabeth wanted to be held at the same time. I found myself with Matthew on my left arm and Elizabeth on my right most of the day. I wished I had more arms. I wished I had a clone to help me during this time. I wished it was the weekend already so Bill would be home to help during the day.

Matthew has lost weight, as expected. He was noticeably lighter. The good news is we've successfully kept him hydrated so far though. Yay for little victories! In addition to taking water from an oral syringe, he sometimes timidly licked frozen apple juice.



I called the ENT's office today to ask if Matthew could have waffles and crackers. I was happily surprised when the doctor gave us the green light. Actually, it was more a yellow light - proceed with caution. If he has trouble swallowing or started bleeding, then we pull back.

Matthew had been begging for waffles since Day 1. He was happy that I actually let him have a waffle today. He did not have trouble swallowing it. After he ate 2 blueberry toaster waffles, he miraculously drank his milk, stopped whimpering and was content playing with his toys. The magical effects of the waffles lasted about 2 hours. Then it was back to whimpering and wanting to be held constantly, which I don't mind at all. I would cuddle with him all day if I didn't have to feed Elizabeth, change her diaper, eat, drink or go to the bathroom.

Day 7 - November 2
Today was the most frustrating day for me. The frustration, helplessness, stress and lack of sleep that had been building since Day 2 overwhelmed me today. I had a difficult time coping. Where was my clone when I needed one?

Matthew refused to nap in the afternoon but he could've used one. His crying woke up Elizabeth. I held both of them. Elizabeth was in the baby bjorn, off-centered toward my left, and Matthew on my right. If I sat down, Elizabeth started crying. If I walked, Elizabeth calmed down but Matthew started crying.



I captured this moment for posterity sake, carrying about a total of 45 pounds. Maybe 5 years from now, I will look at this photo and laugh.

He only needed Tylenol once today. Hoping for a better day tomorrow.

Day 8 - November 3
I let Matthew eat animal crackers today. He was shoving animal crackers into his mouth and leaving crumbs all around him, much like Sesame Street's Cookie Monster.

Overall, Matthew was in a better mood today. He whimpered wanted to be held twice in the morning only afterwhich he happily played with his toys. He was refusing to cuddle with me the rest of the day. No Tylenol today. Signs of a full recovery? I'm hoping!

Teeth grinding continues but it doesn't seem like it's as bad or as loud. It needs to stop.

Day 9 - November 4
Matthew has fully recovered! Matthew is definitely back to his usual self except he still grinds his teeth and he's still not drinking as much milk as he used to. He's down to 8 oz. of milk per day when he used to drink at least 32 oz. in a day.

I'm happy to report that we did not experience any post-surgery bleeding. I had also expected him to have horrible bad breath, as reported by some parents who had gone through this experience as well, but his breath was fine. We also did not use the liquid Tylenol with codeine at all.